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Archive for the ‘Cancer’ Category

sunsetDalam tiga minggu terakhir saya melakukan FNAB, saya terkesan hanya pada dua kasus dan  mendapatkan hasil pembacaan biopsi dibawah mikroskop sebagai kanker darah yang paling ditakuti : Leukemia dan Non Hodgkin Limfoma.

Pasien pertama adalah seorang bapak berusia 69 tahun yang datang dengan muka sangat pucat , tampak sangat lemah dan nafas tersengal-sengal menaiki tangga ke lantai dua laboratorium saya dibantu oleh istrinya. Pasien datang kiriman seorang dokter penyakit dalam disebuah RS. di Pekanbaru. Dikirim dengan pembesaran kelenjar getah bening pada kedua inguinal yaitu selangkangan kanan dan kiri. Diameter kelenjar getah bening antara 1,5-2 cm, yang terfixir dan agak nyeri baik spontan maupun bila benjolan ditekan.

Dokter internist belum memeriksa darah tepi bapak itu. Perkiraan saya Hbnya paling tinggi 6 gram/dl pada saat saya melihat bagian dalam kelopak mata bawah bapak itu. Dia begitu lemah dan pada saat berbicara tangannya gemetar. Pasien mengeluh badannya hangat-hangat sejak 3 bulan lewat, kemudian berlanjut dengan timbulnya benjolan pada kedua selangkangannya yang dirasakan berdenyut hilang-timbul. Pasien adalah pensiunan guru SD.

Dua hari setelah FNAB, saya menerima telpon dari dokter internist yang menyampaikan bahwa lekosit bapak itu 31.000/dl dengan dominasi sel limfoid dan Hb 6,4 gram/dl serta dijumpai cukup banyak sel limfoblast pada darah tepinya. Jadi sesuai dengan temuan saya pada saat FNAB, bapak tadi sangat dicurigai menderita CLL (Chronic Lymphocytic Leukemia). Sudah tentu diagnosis baru dapat ditegakkan setelah dilakukan pemeriksaan bone marrow puncture (BMP) alias pemeriksaan sumsum tulang. Dan dapat dilihat dari buku teks bahwa  penyebab leukemia pada bapak ini adalah virus (HTLV-1) human T-lymphocyte virus strain-1.

Untuk pertama kali saya  tahu dan mendengar langsung dari seorang pasien wanita yang baru sembuh dari leukemia (CLL) yang dideritanya. Ibu itu tidak tampak sakit berat, dari sudut pandang saya kelihatan sangat sehat dengan wajah dan sorot  mata yang memancar sehat. Katanya berobat di Singapore Mount Elizabeth Hospital dan Melaka. Diberi terapi Leukeran tablet produksi GlaxoSmithKline  yang isinya Chlorambucil sebagai cytotoxic agent. Ini berita menggembirakan bagi para penderita Leukemia jenis CLL. I want to share this good news with others, so  go on reading this post… 

Tablet diminum 3 tablet dipagi hari dan 2 tablet pada sore hari. Setelah minum selama 5 hari berturut-turut dan istirahat 25 hari, maka satu bulan setelah minum obat pertama dilakukan check ulang darah tepi. Hasilnya amat sangat menggembirakan, karena dapat menurunkan sel-sel kanker dalam jumlah yang sangat signifikan. Selanjutnya ibu itu tidak pernah merasakan rambut rontok sebagaimana biasanya pada mereka yang mendapat obat keras (khemoterapi).

Pasien kedua seorang wanita berusia 29 tahun yang merasakan benjolan sejak 2 (dua) bulan dileher kanan dan kiri. Pembesaran KGB berdiameter 4 dan 5 cm, terdiri atas beberapa KGB yang sudah melekat satu sama lain (konglomerasi). Disertai penurunan berat badan (BB) yang drastis sampai 15 kilogram dalam dua bulan terakhir. Berat badannya kini tinggal 40 kilogram. Penderita juga merasakan badan lemah dan meriang tanpa sebab yang pasti. Kelihatan pucat dan sakit berat.

Keesokan harinya suami pasien datang dengan membawa hasil CT-scan 64 slices dengan hasil : pembesaran KGB para-aorta dan mesenterial. Dari buku teks, Non Hodgkin Lymphoma juga disebabkan oleh virus, yaitu EBV  terutama pada Hodgkin Lymphoma. Epstein-Barr Virus (EBV) juga menyebabkan kanker hidung, karsinoma nasofaring (KNF). Nah lo, lagi-lagi virus sebagai penyebab…

Kenapa virus mudah menghinggapi seseorang ? Orang terpapar virus dapat menjadi sakit atau tidak. Yang menjadi sakit setelah paparan virus, biasanya adalah yang daya tahan tubuhnya rendah dan yang tubuhnya sangat rentan terhadap invasi virus, dll. Yang tidak mudah terkena penyakit setelah paparan virus, sudah tentu yang berdaya tahan tubuh tinggi  serta tidak rentan terhadap invasi jasad renik seperti virus, dll.

Karena itu sudah menjadi kewajiban kita masing-masing untuk mempertahankan daya tahan tinggi tubuh kita sendiri. Caranya ? Dengan asupan makanan bergizi, istirahat yang cukup, olah-raga 2-3 kali per minggu serta berpikir positif selalu. Buang jauh-jauh rasa sirik, dengki, iri hati dan bermusuhan serta perasaan sedih yang teramat sangat, karena semua itu bersifat negatif dan sudah pasti akan berdampak pada kesehatan secara umum. Energi negatif tersebut akan menurunkan daya tahan tubuh kita. So, be friendly to everybody and the environment. And last but not least be happy always,  no matter you have problems…

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15 Comments | Category: Bahasa, Cancer

Lately, I think I’ve short of time. So many cases that I have to handle, to be examined first by me and later on be processed by my technician which at last I have to look at the microscope to see and finally reveal the diagnoses.

BREASTThe first case was a radical mastectomy from a 37 years old woman with breast cancer. One week ago this patient was done a biopsy on a 6 centimeters lump of her right breast, which already diagnosed with Invasive Ductal Carcinoma. The specimen was measured 15x 15x 3 cm, with nipple and skin attached on it. I have to see diligently, if all the margins of the operation : cranial, caudal, medial, lateral and base of the section were all free from tumor cells. So did to the possibility of vascular invasion or tumor emboli and lymph nodes dissected from her axilla or her right armpit. I found there were massive vascular invasions and infiltration of tumor cells to all the twelve lymphnodes of her right armpit.

OVARYThe second case was a huge ovary cancer of a 43 years old woman. The specimen measured 16x 9x 7 cm, with a hard portion almost to the entire specimen. The outer surface was glistening, greyish-white. On slicing, I found an enormous greywhitish fleshy mass with rubber to hard consistency which later on I’ve made a diagnosis of Solid Embryonal Carcinoma of the Ovary. Under light  microscope the morphology was almost like seminoma, but without lymphocytes infiltration in the stroma. I think the malignancy of this Solid Embryonal Carcinoma of the ovary is moderate. This patient has a bleak prognosis, because there’s already metastases to the peritoneum with adhesions to her bowels and many nodules on her liver..

MYOMAThe third case was a huge fibroid tumor of the womb or Benign Uterine Leiomyoma . The specimen measured 16 centimeters in diameter. On cut surfaces it looked fleshy fresh with  bleeding spots. This specimen from a woman, 42 years of age. Imagine how big was her stomach before the operation  taken to throw out her solid benign tumor of her womb which she has had for 3 years’ time.

ThyroidThe fourth case was a male patient, 56 years of age with a lump on his thyroid gland left lobus measuring 4 centimeters in diameter. This lump was known only 3 months before visiting my laboratory. Rubber consistency and a bit painful on palpation. He admitted that he got fever and difficulty in swallowing and feels short of breath. I’ve done a fine needle aspiration biopsy to his lump. And ultimately my diagnosis was Subacute Thyroiditis or de Quevain’s Thyroiditis. Lucky for him that his tumor need not to be operated, and will be fine and back to normal within 2-3 weeks time with only antibiotic and steroid tappering off therapy.

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6 Comments | Category: Cancer

MIKROSMamma Ca 2Mamma CaSatu minggu yang lalu saya mendapat kiriman jaringan tumor yang berasal dari payudara seorang ibu, berusia 45 tahun. Sebelumnya pasien ini telah dibiopsi-operasi dan saya diagnosis Invasive Ductal Carcinoma, Mammae.

Kali ini yang saya terima jaringan payudara berukuran 17x 10x 8 cm yaitu hasil operasi mastektomi radikal. Tampak puting susu dengan posisi yang masih baik, tidak tertarik kearah dalam,  dan juga  jaringan kulit yang menutupi seluruh payudara masih tampak normal, tidak seperti kulit jeruk (peau d’orange).

Juga dikirim ke laboratorium PA, jaringan bertanda benang yaitu kelompok kelenjar getah bening pada level I, berjumlah 6 buah.

Kenapa semakin banyak saja wanita Indonesia yang terkena kanker payudara ? Read the rest of this entry »

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112 Comments | Category: Bahasa, Cancer, Popular Health

KANKER PARU AKanker ParuSelama dua tahun bekerja di Pekanbaru sudah beberapa kasus kanker paru yang saya dapat. Umumnya penderita berusia 40-an tahun. Dan dari anamnesis, semuanya adalah perokok berat yang menghabiskan rokok lebih dari satu bungkus per hari. Read the rest of this entry »

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35 Comments | Category: Bahasa, Cancer, Popular Health

DUGEMCancer of the uterine cervix until now is the leading cancer among women in the third world and developing countries, inclusive Indonesia.

Most of the type of this deadly cancer is Squamous Cell Carcinoma (SCC), and after that adenocarcinoma or adenosquamous carcinoma and other rare types.

Lately experts have found a new vaccine that could protect women from this lethal disease. The vaccine was made against human papilloma virus (HPV) infection, that we believe is the number one cause of SCC. Read the rest of this entry »

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2 Comments | Category: Cancer, Popular Health

cytology 2cytologyAn old female patient came with dyspneu, very heavy breathing, due to plentiful of effusion on her right pleura. This effusion then aspirated by the pulmonologist and sent to my laboratory. Read the rest of this entry »

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10 Comments | Category: Cancer

microsA few days ago, I’ve done a fine needle aspiration biopsy(FNAB) on a big lump in the neck of a female patient, 34 years of age. She has the lump since 20 years ago, it grows bigger and bigger until a diameter of 15 cm, when the first time she saw me. At that time I made a diagnose of adenomatous goiter, due to the abundant macrophages seen on her slides. Read the rest of this entry »

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4 Comments | Category: Cancer

Today I feel bad, because one of the patient was dead a few hours ago. ..

Renal Cell Carcinoma, Grade-4The patient was 70 years old and he underwent right nephrectomy 3 days ago, for a kidney tumor on his right which was started just two months ago, according to his daughter. His right kidney measuring 14 cm at the biggest diameter. Hematuria was his chief complain, besides one big lump on his left cheek measuring 3 cm in diameter, also started about the same time, two months ago. Read the rest of this entry »

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2 Comments | Category: Cancer

Lobular CarcinomaLately the incidence of breast cancer among Indonesian women is getting higher and higher. In the last 5 years this deadly cancer is approaching the incidence of uterine cervical cancer that rank as number one cancer among women in Indonesia. Read the rest of this entry »

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5 Comments | Category: Cancer, Popular Health

I don’t exactly remember, if this kind of hematologic neoplasia coud occur in such old person. What I know, is the cyto-morphology of this patient seemed to show Reed Sternberg cells on my assestment.

But I still consider this case of being an NHL, with Pleomorphic peripheral T-cell Lymphoma type, which is caused by viral infection (HTLV-I). I do have the smear slides, but forgot to take picture of this patient with enlargement of submental lymph node and a large bulky lump on his left neck. He is doing good, but.

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5 Comments | Category: Cancer, General

  • About

    Dr. Sukma Merati, DSPADr. Sukma Merati is founder and owner of Riau Pathology Center in Pekanbaru, Riau. Dr. Merati has had various international experience and training, including as a fellow doctor at The Mount Sinai Hospital in New York City, NY, USA (2000-2002). More >

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